Determining priority for joint replacement: comparing the views of orthopaedic surgeons and other professionals

Abstract

Objective: To assess which patient characteristics influence the assessments of urgency for surgery by orthopaedic surgeons and non‐orthopaedic professionals. Design, setting and participants: Cross‐sectional study of 80 patients requiring elective hip or knee replacement attending a public hospital orthopaedic outpatient clinic or orthopaedic surgeon's private rooms. Patients were interviewed after being placed on the surgery waiting list. The interview asked about the severity of their joint disease and its effects on physical capability, psychological distress and social circumstances. Patient interviews were summarised and presented to assessors who ranked groups of eight patients in order of their perceived urgency for surgery. Eleven orthopaedic surgeon assessors completed 360 patient ratings and nine non‐orthopaedic assessors from various professions, including physiotherapy, social work, research, management and engineering, completed 720 patient ratings. Main outcome measures: Visual analogue scale rating of patient urgency for surgery; patient rankings for surgery; scores for individual domain contributions to urgency rating. Results: A broad spread of perceived urgency was evident among the patients. For each group of eight patients, there was moderate agreement on overall urgency rankings between the two groups of assessors. Linear regression demonstrated that pain was the dominant determinant of urgency score for both assessor groups. Orthopaedic surgeons also took into account limitations to mobility and concurrent medical illness but gave less priority to psychological distress or social circumstances. For the non‐orthopaedic assessors, limitations to mobility, social circumstances and psychological distress also contributed to urgency. Conclusion: Both orthopaedic surgeons and non‐orthopaedic professionals considered pain the most important factor in establishing urgency and priority for joint replacement. Only the non‐orthopaedic professionals considered psychosocial factors important when determining priority for surgery. Broader community discussion about prioritisation for elective surgery is needed to facilitate agreement about which patients factors should be considered.

Clinical management issues vary by specialty in the Victorian Audit of Surgical Mortality: a retrospective observational study

“…‘Delay in definitive treatment’ was identified as the most severe clinical management issue from this study and from the national report data 13. In orthopaedic clinical studies on hip fracture patients, delay in definitive treatment was shown to be attributable to patient factors such as age and comorbidities, as well as waiting times to theatre 14 15. In the aggregate results, ‘communication issues or poor documentation’ was in the top seven clinical management issues.…”

Criteria used when deciding on eligibility for total knee arthroplasty — Between thinking and doing

“…However, looking at the explained variation from the univariable analyses pain and functional limitations explained less variation in TKA eligibility than both comorbidities and BMI with radiographic severity explaining most of the variation in TKA eligibility. Since pain is considered one of the key criteria for TKA eligibility [3,7,9,10,31], it was expected that it would be one of the most important predictor criteria.…”

“…This could be due to the fact that pain, disability and radiographic severity poorly reflect the complexity of decision-making when the orthopaedic surgeon (OS) evaluates eligibility for TKA/THA [3,6,8]. 4 Other criteria considered important for TKA eligibility and/or suggested in the literature to affect the decision-making are: Not responding to the recommended non-surgical treatments [3], duration of symptoms [9], being medically fit [3,10], age [3,9] and Body Mass Index (BMI) [3,9]. However, no reports exist on whether criteria considered important for TKA eligibility are actually applied in clinical practice, or which combination of criteria best reflect the complexity of the decision on eligibility.…”

Sources of information used by patients prior to elective surgery: a scoping review

“…Elective surgery is a term used to describe non-emergency surgery which is medically necessary, but which can be delayed for at least 24 hours 1. There has been an increasing demand for elective surgery in Australia over the past decade, however, the capacity of health systems to respond to has been limited by funding and workforce availability 2…”